Biomedical subjects

J M Maréchal

Publications and source records attributed to J M Maréchal.

At least 19 recordsLinked to original sources

PubMed2004

Randomized Phase II trial assessing estramustine and vinblastine combination chemotherapy vs estramustine alone in patients with progressive hormone-escaped metastatic prostate cancer.

Based on the results of combined data from three North American Phase II studies, a randomised Phase II study in the same patient population was performed, using combination chemotherapy with estramustine phosphate (EMP) and vinblastine (VBL) in hormone refractory prostate cancer patients. In all, 92 patients were randomised into a Phase II study of oral EMP (10 mg kg day continuously) or oral EMP in combination with intravenous VBL (4 mg m(2) week for 6 weeks, followed by 2 weeks rest). The end points were toxicity and PSA response in both groups, with the option to continue the trial as a Phase III study with time to progression and survival as end points, if sufficient responses were observed. Toxicity was unexpectedly high in both treatment arms and led to treatment withdrawal or refusal in 49% of all patients, predominantly already during the first treatment cycle. The mean treatment duration was 10 and 14 weeks, median time to PSA progression was 27.2 and 30.8 weeks, median survival time was 44 and 50.9 weeks, and PSA response rate was only 24.6 and 28.9% in the EMP/VBL and EMP arms, respectively. There was no correlation between PSA response and survival. While the PSA response in the patients tested was less than half that recorded in the North American studies, the toxicity of EMP monotherapy or in combination with VBL was much higher than expected. Further research on more effective and less toxic treatment strategies for hormone refractory prostate cancer is mandatory.

Administration, Oral↗

PubMed2003

[Cystic lymphangioma in the adrenal gland: a case report].

Cystic lymphangioma of the adrenal gland are rarely encountered tumoural formations with no clinical expression. Pre-operative diagnosis is difficult. Echography and CT scan are essential exploratory techniques, diagnosis is histological. Usually surgical exploration is indicated due to uncertain diagnosis. We report a new case of cystic lymphangioma of the adrenal gland and a review of recent literature.

Adrenal Gland Neoplasms↗

PubMed2001

[Bilateral adrenal pheochromocytomas in von Hippel-Lindau disease].

The pheochromocytoma is a medullo-adrenal tumor which develops at the cost of the chromaffin cells. It appears in 11-19% of cases of von Hippel-Lindau's disease (VHL), is often bilateral, and the symptomatology is often crude: arterial hypertension is frequently isolated and unstable, and the classic triad of headache, palpitations and sweating is quite rarely observed. We report four observations of bilateral pheochromocytomas in patients with von Hippel-Lindau's disease (three with phenotype IIA and one with phenotype IIB). The tumor was bilateral during the diagnosis in three cases; in the fourth patient, the attack on the contralateral adrenal gland came two years after the first adrenalectomy. All the patients had undergone an adrenalectomy by open surgery after a short preparation of 48 hours; replacement therapy was begun in each patient. Morbidity was low, and the patients submitted to a prolonged follow-up in order to screen for the onset of future lesions of VHL.

Adrenal Gland Neoplasms↗

PubMed2001

[Recanalization of pelvic ureter in prostatic neoplastic obstruction: endoscopic and radiologic approach].

UNLABELLED: Obstruction of the lower ureter by pelvic cancer requires a palliative treatment. Percutaneous derivation is often performed as an emergency. If obstruction is limited to the peri-meatic area (a few mm or a cm) resection of the ureteral orifice can be enough to catheterize the obstructed ureter. Stenting of the ureter can be done even if the obstruction is longer, using the extra vesical repermeabilization. METHODS: A guide wire is passed via the nephrostomy, and ureteral stent is passed over the guide wire. Dye additionned with methylene blue is injected tovisualize the lower extremity of the ureter. A regular resectoscope is placed transuretraly, and resection is conducted using X ray localisation with a C arm and several incidences. The tissue resected first is usually extravesical, in the adipous perivesical tissue. Dissection of this area can be performed bluntly with the tip of the resectoscope until the ureter is reached. At this time, the resectoscope is used to open the lower extremity of the ureter, localized with the C arm. It is important to open widely the ureter, so as to be sure to catheterize easily this opening with a ureteral catheter. A double J can then be passed easily. Tunnel of several cm can be performed using this technique. RESULTS: Seven patients with pelvic cancer with obstruction of the last cm of the pelvic ureter were included in this series. They were recurrent prostate cancer already treated with hormone therapy, stage T3, T4. All procedures were performed under rachianesthesia or general anesthesia according to general status. After this procedure normal miction were obtain in all patients and nephrostomies were removed. This technique is possible for extended pelvic obstruction. Blunt dissection with the endoscope is usualy blood less. This palliative procedure can be done in patients with poor general condition and allows for a better quality of life than nephrostomy or urinary diversions.

Aged↗

PubMed2000

Intra-operative electron radiotherapy as a conservative treatment for infiltrating bladder cancer.

The intent of this feasibility study was to evaluate the use of intra-operative electron radiotherapy (IOERT), after transurethral resection (TUR), combined with external beam radiation with concurrent chemotherapy for the conservative treatment of infiltrating bladder cancer. From November 1988 to June 1998, 27 patients with histologically proven non-metastatic infiltrating bladder cancer were included in this protocol. The treatment consisted of: TUR, external beam irradiation (x18 MV:48 Grays (Gy)/24 fractions/5 weeks), with concurrent chemotherapy (cisplatin 30 mg/day for 3 days-two cycles during irradiation), followed by control cystoscopy and cystotomy with IOERT (e 9 MeV:15 Gy). 14 patients received two cycles of neoadjuvant methotrexate, vinblastine and cisplatin (MVC) and folinic acid chemotherapy. Patients were evaluated for toxicity, local control and survival. The 5-year overall and cystectomy-free survival rates were 53.3% +/-11.1% and 48.1%+/-11.4%, respectively. 4 patients developed infiltrating intravesicular recurrence (3 were treated by salvage cystectomy), and an additional patient developed a superficial recurrence. 2 patients subsequently developed regional recurrence in pelvic nodes and 10 patients were found to have distant metastases. The protocol was found to be feasible and associated with acceptable toxicity. Early and late toxicities consisted of 3 cases of bladder mucosal necrosis or ureteral stenosis which resolved with medical management. These preliminary results indicate that IOERT combined with TUR and neoadjuvant external beam radiation with concurrent chemotherapy is feasible. It could be considered as an alternative therapy for infiltrating carcinoma of the bladder, especially in patients unfit for radical surgery, and is well adapted to treat lesions of the fixed portion of the bladder.

Adult↗

PubMed1999

Mutations of the VHL gene in sporadic renal cell carcinoma: definition of a risk factor for VHL patients to develop an RCC.

To investigate the nature of somatic von Hippel-Lindau (VHL) mutations, we analyzed 173 primary sporadic human renal cell carcinomas for mutations of the VHL tumor suppressor gene, using polymerase chain reaction (PCR) and single-strand conformational polymorphism analysis (SSCP) of DNA. We detected abnormal SSCP pattern in 73 samples. After sequencing, we identified microdeletions in 58% of cases, microinsertions in 17%, nonsense mutations in 8%, and missense mutations in 17%. Among these mutations, 50% correspond to new mutations. VHL mutations were found only in the nonpapillary renal cell carcinoma (RCC) subtype, as previously reported. To compare somatic and germline mutations, we used the VHL database, which includes 507 mutations. The study of mutational events revealed a significant difference between somatic and germline mutations with mutations leading to truncated proteins observed in 78% of somatic mutations vs only 37% in germline mutations (P < 0.001). We postulated that a specific pattern of VHL mutations is associated with sporadic RCC. This pattern corresponds to mutations leading mainly to truncated proteins with few specific missense mutations. We then analyzed the occurrence of RCC in VHL families, based on the nature of mutations. We observed RCC in at least one member of the VHL families in 77% of cases with mutations leading to truncated proteins versus 55% in cases with missense mutations (P < 0.05). Thus, mutations resulting in truncated proteins may lead to a higher risk of RCC in VHL patients.

Adult↗

PubMed1998

[Laparoscopic surgical treatment of simple cysts of the kidney].

OBJECTIVE: To demonstrate the efficacy of laparoscopic treatment of symptomatic renal cysts or cysts suspicious of malignancy. MATERIAL AND METHODS: 10 patients (mean age: 58 years) were operated by laparoscopy either for compressive or symptomatic cysts (7 cases), or for cysts suspicious of malignancy (3 cases). The mean cyst diameter was 7.8 cm. All patients were evaluated by preoperative CT scan. There were 8 Bosniak type I and 3 Bosniak type II cysts. RESULTS: The procedure was performed via an intraperitoneal approach (8 cases) or via a retroperitoneal approach (2 cases). The mean operating time was 92 min and the mean hospital stay was 5.4 days. One patient was operated (conversion to lumbotomy) for uncontrolled haemorrhage of the base of the cyst. The 10 cysts were found to be benign histologically. All 10 patients are asymptomatic (mean follow-up: 8.3 months) with disappearance of the cyst on the follow-up CT scan. CONCLUSION: Laparoscopic treatment of renal cysts is feasible and effective. However, this treatment must be reserved for Bosniak type I and II cysts, associated with a low risk of malignancy.

Adult↗

PubMed1997

[Adjuvant radiotherapy after radical prostatectomy. Apropos of a series of 73 patients in Lyons (France)].

PURPOSE: Descriptive analysis of adjuvant radiation therapy after radical prostatectomy. MATERIALS AND METHODS: From 1986 to 1993, 73 patients (median age, 64.5 years; Gleason score > or = 7 : 36 pts; T1:22; T2:40; T3:11) were included into the study. On the operative specimen, the cancer grades were pT2:5 (involvement of the apex), pT3:67, pT4:1, pN1-2:8. Radiation therapy was performed after a mean resting period of 112 days. The target volume was the prostatic area. The technique used was a four-field box with an 18 MV-X photon beam. The dose was 50 Gy/20 fractions/5 weeks. No hormonal treatment was administered, except for 5 patients for a short duration. RESULTS: The median follow up was 46 months. One anastomotic local failure was salvaged by trans-urethral resection, three distant metastatic failures. Out of 72 patients with a PSA < 3 ng/mL at the end of radiotherapy, 13 showed an isolated elevation. The 5-year overall survival rate was 93%. The event-free survival was 72% after 5 years. Pathological differentiation and Gleason score were significantly correlated with the survival. There was no complication related to radiotherapy. CONCLUSION: Elective adjuvant radiation therapy for pT3 prostate adenocarcinoma after radical prostatectomy provides a good local control with minimal morbidity.

Adenocarcinoma↗

PubMed1997

Endopyelotomy with the Acucise cutting balloon device. Early clinical experience.

OBJECTIVES: To evaluate the efficacy of the Acucise balloon cutting device in the treatment of ureteropelvic junction (UPJ) stenosis. METHODS: Forty-four patients with primary (21) or secondary (23) UPJ stenosis underwent Acucise endopyelotomy between July 1992 and February 1995. RESULTS: The average operating time was 53 min and the average hospital stay was 6 +/- 4 days. The follow-up schedule included a symptom questionnaire, intravenous urography and diuretic renal scan. Of the 44 patients, 38 have been followed for a minimum of 3 months postoperatively (mean: 12 months, range: 3-39 months). Overall success was achieved in 29 (76%). The procedure was successful in 16 out of 19 cases (84%) with secondary strictures. When the technique was used for the treatment of primary UPJ strictures, the success rate was only 68% (13 out 19). The presence of a large periureteric urinoma was identified as the cause of failure in 2 cases of primary strictures. CONCLUSION: We recommend the use of the Acucise device as the first-line therapy for treatment of secondary UPJ stenosis (except in the presence of large enclosed stones). We do not approve the use of the Acucise device for treatment of primary UPJ strictures. In primary hydronephrosis, the negative role of periureteric extravasation probably explains the low success rate of 68% (as opposed to 85% for a large series of percutaneous endopyelotomies.

Adolescent↗

PubMed1996

Correlations of allelic imbalance of chromosome 14 with adverse prognostic parameters in 148 renal cell carcinomas.

To investigate cumulative genetic alterations during development and progression of renal cell carcinoma (RCC), we examined DNAs that were isolated from 148 RCCs for allelic imbalance (AI) at four loci on chromosome arm 3p and at 26 loci on chromosome arm 14q by using polymorphic microsatellite markers and densitometric scanning. Because the analysis of solid tumor unbalanced rearrangements remains difficult due to the large proportion of cells that infiltrate from the stroma, we developed a method for the detection and quantification of AI between control and tumor samples by using polymerase chain reaction (PCR) amplification of microsatellite markers. This technique allows detection down to 20% of contaminating cells with good accuracy. We detected AI on 3p and 14q in 57 and 28% of RCC, respectively. A comparison of genetic changes with clinicopathological data showed that, in marked contrast to AI on 3p, AI on 14q was correlated significantly with the stage and grade of the tumors, with 56 and 58% of RCC in Stage IV and Grade 4, respectively, showing AI. Our results suggest that tumor suppressor genes on 3p, including the von Hippel-Lindau gene, may be involved in early steps of carcinogenesis in clear cell carcinoma and that AI on 14q may play an important role in the progression of clear cell and papillary chromophilic cell carcinomas. Loss of heterozygosity (LOH) on 14q may be a new prognostic factor in RCC. Despite the size of the series of tumors and the number of markers used, only rearrangements that involved the whole length of the long arm of chromosome 14 were observed in the present study. The localization of the putative tumor suppressor gene on 14q will require further investigation of RCC with structural rearrangements of 14q.

Adult↗

PubMed1996

Surgical management of complex renal cysts: a series of 32 cases.

PURPOSE: The differentiation between benign cysts of the kidney and those that require surgical exploration remains difficult. The accuracy of radiological techniques (ultrasound, computerized tomography [CT], angiography, magnetic resonance imaging, cyst puncture and intraoperative pathological examination) is analyzed. MATERIALS AND METHODS: Surgical exploration was performed in 30 patients with 32 asymptomatic renal cysts, and the pathological specimens were compared retrospectively to the radiological findings. The classification of Bosnaik was used to categorize the ultrasound and CT findings. RESULTS: Of our complex renal cysts 41% proved to be malignant. Our results suggest that the radiological techniques are not well suited for characterization of these cysts. None of the Bosnaik types was sufficiently predictive of the lesion. Only a Bosnaik score of 4 (the sum of ultrasound and CT Bosnaik types) was not associated with renal cell carcinoma. According to the radiological findings, 1 patient was under treated (recurrent renal cell carcinoma) and 4 were over treated (radical nephrectomy for benign lesions). CONCLUSIONS: A practical therapeutic strategy is described in which radical nephrectomy is performed when malignant lesions are detected either by preoperative or intraoperative techniques. Conservative surgery is indicated for benign cysts according to the clinical status and risks of nephron sparing surgery.

Adult↗

PubMed1996

[Quality of life and skin urinary diversions. Results of a questionnaire completed by 73 patients].

UNLABELLED: The objective of this study was to evaluate the quality of life of patients with a cutaneous urinary diversion. MATERIAL AND METHODS: A 25-item self-administered questionnaire was sent to 73 patients with a cutaneous urinary diversion, either non-continent (NCD), such as a transileal cutaneous ureterostomy, or continent (CD), such as a Mainz or Kock reservoir. RESULTS: 66 patients answered the questionnaire: 34 NCD and 32 CD. The mean follow-up was 69.2 years for NCD and 58 years for CD. No significant difference was demonstrated between the two samples in terms of the interference of their diversion with their everyday life. Most patients declared that their sex life was now "severely disturbed". However, 3 patients regained a sexual activity after their diversion. Patients with an ideal conduit presented a higher incidence of stoma problems. Overall, 90% of patients with an NCD and 97% of those with a CD were satisfied or very satisfied with their diversion. CONCLUSION: Regardless of the type of diversion, patients were satisfied with their operation. When a cutaneous diversion is necessary, the choice of a continent or non-continent diversion cannot be solely based on the argument of "continence". The best possible choice, as a function of surgical limitations and the patient's desires, can only be determined on the basis of a dialogue between the surgeon and the patient.

Dermatologic Surgical Procedures↗

PubMed1995

[Radical prostatectomy].

Radical prostatectomy can cure cancer of the prostate if the malignancy is localized within the gland and the patient has a life expectancy sufficiently long enough to appreciate efficacy. The expectations raised by this technical progress, particularly since the number of diagnosed cases is constantly on the rise, should however be tempered by questions concerning indications and therapeutic efficacy, pathology findings in surgical specimens, factors of prognosis and certain doubts about the quality of life, therapeutic alternatives and cost evaluation. 10-year survival after radical prostatectomy is 85% for localized (pT1 and pT2) forms and prostate specific antigen levels provide an easily accessible means of detecting recurrence. However, due to the insufficient sensitivity of imaging techniques, preoperative staging is generally underestimated compared with pathology reports. Postoperative incontinence is the major factor in quality of life after prostatectomy and has been estimated to concern from 0% to 26% of the patients. No comparative data is available to evaluate alternative treatment such as external radiotherapy. These observations emphasize the uncertain nature of current indications for radical prostatectomy and the importance of further research.

Humans↗

PubMed1995

[Lymphoma with bladder involvement and renal transplantation].

Based on the case of a renal transplant recipient who developed a monoclonal B cell lymphoma with plasma cell differentiation, arising in the bladder, the authors discuss the responsibility of intensive immunosuppressant protocols in the development of post-transplantation lymphoproliferative syndromes. The Epstein-Barr virus favours the development of these lymphomas. The bladder is a rare site. Diagnosis was based on endoscopic resection with immunohistochemical analysis. The prognosis depends on the stage at the time of diagnosis. At an early stage, resection of the tumour combined with reduction of immunosuppressant therapy may be sufficient, but more aggressive treatment is required for more advanced stages. Anti-B lymphocyte monoclonal antibodies (CD21, CD24) give good results, especially in polyclonal forms and Epstein-Barr virus primo-infections. Anti-CD38 monoclonal antibodies are currently being investigated and appear to be very promising. Conventional radiotherapy and chemotherapy are disappointing.

Herpesviridae Infections↗

PubMed1995

[Endoscopic treatment of intermittent vesico-ureteral reflux in women. Apropos of 40 cases].

UNLABELLED: To evaluate the clinical efficacy of endoscopic treatment of intermittent vesicoureteric reflux in adult females. METHODS: Forty women presenting with recurrent urinary tract infection related to intermittent vesicoureteric reflux, underwent subureteric Teflon injection according to the O'Donnell procedure (mean volume of Teflon 1 cc). Thirty patients required one injection, while nine patients needed two injections. Meatostomy or urethral dilatation were associated in 29 cases (72.5%). RESULTS: No complication occurred. Clinical results were evaluated using a questionnaire. The mean follow-up was 33.5 months (range 12-72), complete disappearance of infection was obtained in 31 out of 40 cases (77.5%). Recurrent urinary infection occurred in 9 cases. After complementary Teflon injection, urinary infection disappeared in 5 patients and finally a complete cure was obtained in 36 out of 40 cases (90%). CONCLUSION: Intermittent vesicoureteric reflux could be easily cured by an endoscopic procedure. This minimally invasive technique is simple and well adapted to this relatively benign disease.

Adolescent↗

PubMed1994

[Melanosis of the prostate. A new case and review of the literature].

Melanin may be found within fibromuscular prostatic stroma and/or in prostatic epithelium. An example of prostatic melanosis, with histochemical and immunohistochemical studies is reported. The pathologic description and the histogenesis of this rare entity are discussed.

Humans↗

PubMed1993

Benign prostatic hypertrophy treatment by transurethral radiofrequency hyperthermia with Thermex II.

We selected 50 patients with benign prostatic hyperplasia to be treated with hyperthermia at 44.5 degrees C. The treatment was performed with Thermex II. We excluded from this study all patients with a suspicion of prostatic adenocarcinoma or other previous surgical intervention on the prostate and we also excluded patients with pacemakers or coagulation problems. The follow-up time for these patients was 6 months. They were all evaluated by flow rate, measurement of postmicturation residue. Madsen score and transrectal sonography at 1, 3 and 6 months. We did not notice any modification of the prostatic volume, no modification of the urine residue but a moderate improvement of the flow rate. A significant improvement was observed on the symptom score since subjective symptoms were seen in 68% of the patients. Our results show that this method of treatment seems to compete with other classic medical treatments especially in the case of patients with a prostatic adenoma equal or smaller than 40 g and that hyperthermia is particularly active on irritative symptoms but does not compete with classic surgical procedures.

Aged↗

PubMed1993

[A quiet revolution: the Wallstent urethral prosthesis (Urolume AMS)].

14 patients (mean age: 57 years) with posterior urethral stricture were treated by internal urethrotomy and implantation of one or several Wallsten prostheses. The stent had to be removed in 2 patients (15%), while 12 patients (85%) obtained satisfactory urethral patency (mean follow-up: 17.5 months). Complications were observed in 50% of cases. They were able to be treated endoscopically with a satisfactory result in 5 out of 6 cases (intraprosthetic calculi or stenosis of the ends of the stent; 2 patients who became incontinent after insertion of the stent regained normal continence after insertion of an artificial sphincter above the stent. The Wallsten endoprosthesis therefore appears to be a very satisfactory treatment for recurrent complex strictures of the posterior urethra.

Adult↗